Provider Demographics
NPI:1508400110
Name:MUECKE, BONNIE KAY (RN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:KAY
Last Name:MUECKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28273 KEY AVE
Mailing Address - Street 2:
Mailing Address - City:MERRILL
Mailing Address - State:IA
Mailing Address - Zip Code:51038-8555
Mailing Address - Country:US
Mailing Address - Phone:712-253-4593
Mailing Address - Fax:
Practice Address - Street 1:820 E 29TH ST
Practice Address - Street 2:
Practice Address - City:SOUTH SIOUX CITY
Practice Address - State:NE
Practice Address - Zip Code:68776-3344
Practice Address - Country:US
Practice Address - Phone:402-494-1662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA063820163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse